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20110127 Salmon Run FS Test Reports Nw�arcxtaE�, FIRE PROTECTION BUREAU_PLAN REVIEW r PO Box 42600 Olympia'WA 98504-2600 ."�`��MS,—, (360) 596-3911 FAX: (360) 566-3934 CONTRACTORS' MATERIALS AND TEST REPORT FOR ABOVEGROUND PIPING PROCEDURE Upon completion of work, inspection and test shall be made by the contractor's representative and witnessed by an owner's representative. All defects shall be corrected and system left in service, before contractor's personnel Finally leave the job. A certificate shall be filled out and signed by both representatives. Copies shall be prepared for approving authorities, owners, and contractor. It is understood the owner's representative's Signature in no way prejudices any claim against contractor for faulty material, poor workmanship, failure to comply with approving authority's requirements or local ordinances. PROPERTY NAME DATE a I nz-v�. u PROPERTYADDRESS ACCEPTED BY APPROVING AUTHORITIES(NAME) ADDRESS PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS ES ❑ NO EQUIPMENT USED IS APPROVED YES ❑NO IF NO,EXPLAIN DEVIATION' HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED,AS TO LOCATION OF CONTOL VALVE AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT? ❑NO IF NO,EXPLAIN INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: 1. SYSTEM COMPONENTS INSTRUCTIONS N3�Y S ❑NO ?. CARE AND MAINTENANCE INSTRUCTIONS [ ES ❑NO 3. NFPA 13 Q`YES ❑NO LOCATION SU'P'PLIES BUILDINGS OF SYSTEM MAKE MODEL YEAR OF MANUFACTURE ORIFICE SIZE QUANTITY TEMPERATURE RATING SPRINKLERS TYPE OF PIPE PIPE AND FITTINGS TYPE OF FITTINGS ALARM DEVICE MAXIMUM TIME TO OPERATE. THROUGH TEST CONNECTION TYPE MAKE MODEL MINUTES SECONDS ALARM VALVE OR FLOW INDICATOR 3000A50-OGI 7107 Rage 1 DRY VALVE QUICK OPENING DEVICE MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO TIME TO TRIP WATER TRIP POINT TIME WATER ALARM OPERATED THRU TEST PRESSURE AIR PRESSURE AIR REACHED TEST PROPERLY DRY PIPE CONNECTION PRESSURE OUTLET OPERATING TEST MIN SEC PSI PSI PSI MIN SEC YES NO WITHOUT Q.O.D. WITH Q.0 D. IF NO.,EXPLAIN OPERATION ❑ PNEUMATIC ❑ ELECTRIC ❑ HYDRAULIC PIPING SUPERVISED ❑ YES ❑ NO DETECTING MEDIA SUPERVISED ❑ YES ❑ NO DOES VALVE OPERATE FROM THE MANUAL TRIP AND/OR REMOTE CONTROL STATIONS? ❑ YES ❑ NO DELUGE& IS THEREAN ACCESSIBLE FACILITY IN EACH CIRCUIT FOR TESTING? IF NO,EXPLAIN PREACTION ❑ YES ❑ NO VALVES DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT OPERATE MAXIMUM TIME TO OPERATE MAKE MODEL SUPERVISION LOSS AI.A.RM? VALVE RELEASE? RELEASE YES NO YES NO YES NO HYDROSTATIC: Hydrostatic levels shall be made at not less that 200 psi(13.6 bars)for two hours of 50 psi(3.4 liars)above static pressure in excess of 150 psi(10,2 bars)for two hours. Differential dry-pipe valve clappers shall be left open during test to prevent damage. All aboveground TEST piping Leakage shall be stopped. DESCRIPTION PNEUMATIC: Establish 40 psi(2.7 bars)air pressure and measure drop which shall not exceed 1 Yx psi(0.1 bars)in 24 hours, Test pressure tanks at normal water level and air pressure and measure air pressure drop which shall not exceed 1%psi 0.1 bars in 24 hours ALL PIPING HYDROSTATICALLY TESTED AT ZCcO FOR , FIRS IF NO,STATE REASON r_ DRY PIPING PNEUMATICALLY TESTED El YES ❑Ni EQUIPMENT OPERATES PROPERLY ❑YES ❑NO DO YOU CERTIFY AS THE SPRINKLER SYSTEM CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS,SODIUM SILICATE OR DERIVATIVES OF SODIUM SILICATE,BRINE OR OTHER CORROSIVE CHEMICALS WERE NOT USED FOR TESTING SYSTEMS OR STOPPING LEAKS? ❑YES ❑NG DRAIN READING OF GAGE LOCATED NEAR WATER SUPPLY TEST RESI'DULE PRESSURE WITH VALVE,IN TEST TESTS TEST CONNECTION: PSI CONNECTION OPEN WIDE: PSI LNDE OUND MAINS AND LEAD IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO SPRINKLER PIP RIFLED BY COPY OF THE U FORM NO 8'5B VR' ES [I NO FLUSHED BY INSTALLER OF UNDERGROUND SPRINKLER PIPING [AYES ❑,NO IF NO,EXPLAIN BLANK TESTING NUMBER USED LOCAT&ONS NUMBER REMOVED GASKETS WELDED PIPING ❑YES ❑NO IF YES,COMPLETE BELOW DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST AWS D10.9,LEVEL AR-3? ❑YES ❑NO WELDING DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS D10.9,LEVEL AR-3? ❑YES ❑NO DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A DOCUMENTED QUALITY CONTROL PROCEDURE TO ENSURE THAT ALL DISCS ARE RETRIEVED,THAT OPENINGS IN PIPING ARE SMOOTH,THAT SLAG AND OTHER WELDING RESIDUE ARE REMOVED,AND THAT THE INTERNAL DIAMETERS OF PIPING ARE NOT PENETRATED? ❑YES ❑ NO CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL DISCS CUTOUTS DISCS ARE RETRIEVED"? ❑YES ❑NO FUNCTIONAL DOES AHJ REQUIRE A FUNCTIONAL FLOW TEST OF RESIDENTIAL SPRINKLERS? ❑YES ❑NO FLOW TEST WERE FUNCTIONAL FLOW TEST RESULTS SATISFACTORY? YES ❑NO HYDRAULIC NAME PLATE PROVIDED DYES [j NO IF NO,EXPLAIN DATA NAMEPLATE REMARKS ATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: v AME OF SPRINKLER CONTRACTOR CONTRACTOR LICENSE# DATE SIGNATURES TESTS WITNESSED BY OWNER OR 56EPR5,81ENTATIVE TITLE DATE L 3000450-001 7107 Page 2 � FIRE PROTECTION BUREAU—PLAN REVIEW l z PO Box 42600 �#� 1 1 Olympia WA 98504-2600 �k�uma�xxx��,� ""••„ '°W (360) 596.3991 FAX; (360) 596-3934 CONTRACTORS' MATERIALS AND TEST REPORT FOR ABOVEGROUND P'IP'ING PROCEDURE Upon completion of work, inspection and test shall be made by the contractor's representative and witnessed by an owner's representative. All defects shall be corrected and system left in service before contractor's personnel finally leave the jab. A certificate shall be filled out and signed by both representatives. Copies shall be prepared for approving authorities, owners, and contractor. It is understood the owner's representative's signature in no way prejudices any claim against contractor for faulty material, poor workmanship, or failure to comply with approving authority's requirements or local ordinances. PROPERTY NAME q FS PROPER ADDRESS ACCEPTED BY AP'PROVI'NG AUTHORITIES(NAME) ADDRESS PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS Q YES Q NO EQUIPMENT USED IS APPROVED Q YES ONO IF NO,EXPLAIN DEVIATION HAS-PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION OF CONTOL VALVE AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT? YES ONO IF NO,EXPLAIN' INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: 1. SYSTEM COMPONENTS INSTRUCTIONS OYES Q NO 2. CARE AND MAINTENANCE INSTRUCTIONS OYES ONO 3. NFPA 13 Q YES Q NO LOCATION SUPPLIES BUILDINGS OF SYSTEM YEAR OF MAKE MODEL MANUFACTURE ORIFICE S12E QUANTITY TEMPERATURE RATING SPRINKLERS TYPE OF PIPE PIPE AND FITTINGS TYPE OF FITTINGS ALARM DEVICE MAXIMUM TIME TO OPERATE THROUGH TEST CONNECTION' TYPE MAKE MODEL MINUTES SECONDS ALARM VALVE OR FLOW INDICATOR 3000450-741 7107 Page 1 DRY VALVE QUICK OPENING DEVICE MAKE MODEL SERIAL NO MAKE MODEL SERIAL NO. TIME TO TRIP TRIP POINT TIME WATER THRU TEST WATER AIR PRESSURE AIR REACHED TEST ALARM OPERATED DRY PIPE CONNECTION PRESSURE PRESSURE OUTLET PROPERLY OPERATING TEST MIN SEC PSI PSI PSI MIN SEC YES NO WITHOUT Q.O.D, WITH Q.O D. IF NO, EXPLAIN OPERATION ❑ PNEUMATIC ❑ ELECTRIC ❑ HYDRAULIC PIPING SUPERVISED ❑ YES ❑ NO DETECTING MEDIA SUPERVISED ❑ YES ❑ NO DOES VALVE OPERATE FROM THE MANUAL TRIP AND/OR REMOTE CONTROL STATIONS? ❑ YES ❑ NO DELUGE& IS THERE,AN ACCESSIBLE FACILITY IN EACH CIRCUIT FOR TESTING? __]7FN_0_,EXPLAIN PREACTION ❑ YES ❑ NO VALVES DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT OPERATE MAXIMUM TIME TO OPERATE MAKE MODEL SUPERVISION LOSS ALARM? VALVE RELEASE? RELEASE YES NO YES NO YES NO HYDROSTATIC: Hydrostatic levels shall be made at not less that 200 psi(13.6 bars)for two hours of 50 psi(3.4 bars)above static pressure in excess of 150 psi(10.2 bars)for two hours. Differential dry-pipe valve clappers shall be left open during test to prevent damage. All aboveground TEST piping leakage shall be stopped. DESCRIPTION PNEUMATIC: Establish 40 psi(2.7 bars)air pressure and measure drop which shall not exceed 1 '%psi(0.1 bars)in 24 hours. Test pressure tanks at normal water level and air eressure and measure air pressure drop which shall not exceed 1 %psi(0.1 bars in 24 hours ALL PIPING HYDROSTATICALLY TESTED AT FOR `2. HRS IF NO,STATE REASON DRY PIPING PNEUMATICALLY TESTED ❑YES ❑NO EQUIPMENT OPERATES PROPERLY ❑YES ❑NO DO YOU CERTIFY AS THE SPRINKLER SYSTEM CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS,SODIUM SILICATE OR DERIVATIVES OF SODIUM SILICATE,BRINE OR OTHER CORROSIVE CHEMICALS WERE NOT USED FOR TESTING SYSTEMS OR STOPPING LEAKS? ❑YES ❑NO DRAIN READING OF GAGE LOCATED NEAR WATER SUPPLY TEST RESICULE PRESSURE WITH VALVE IN TEST TESTS TEST CONNECTION: PSI I CONNECTION OPEN WIDE: PSI UNDERGROUND MAINS AND LEAD IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO SPRINKLER PIPING. VERIFIED BY COPY OF THE U FORM NO 135E DES ❑NO FLUSHED BY INSTALLER OF UNDERGROUND SPRINKLER PIPING [TY'ES ❑NO IF NO,EXPLAIN BLANK TESTING NUMBER USED LOCATIONS NUMBER REMOVED GASKETS WELDED PIPING ❑YES, ❑NO IF YES,'COMPLETE BELOW DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST AWS D10.9,LEVEL AR-3? ❑YES ❑NO DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN WELDING COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS D10.9,LEVEL AR-3? ❑YES ❑NO DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A DOCUMENTED QUALITY CONTROL PROCEDURE TO ENSURE THAT ALL DISCS ARE RETRIEVED,THAT OPENINGS IN PIPING ARE SMOOTH,THAT SLAG AND OTHER WELDING RESIDUE ARE REMOVED,AND THAT THE INTERNAL DIAMETERS OF PIPING ARE NOT PENETRATED? ❑YES ❑ NO CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL DISCS CUTOUTS DISCS ARE RETRIEVED? ❑YES ❑NO FUNCTIONAL DOES AHJ REQUIRE A FUNCTIONAL FLOW TEST OF RESIDENTIAL SPRINKLERS? ❑YES ❑NO FLOW TEST WERE FUNCTIONAL FLOW TEST RESULTS SATISFACTORY? ❑YES 0 N HYDRAULIC NAME PLATE PROVIDED ❑YES [ NO IF NO,EXPLAIN DATA NAMEPLATE REMARKS DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: NAME OF SPRINKLER CONTRACTOR CONTRACTOR LICENSE# DATE SIGNAT TESTS WITNESSED BY P OWNESENTAT IVE TITLE DATE 3000ASO-001 7/07 Page 2 *0"1oe.,�r�Ar FIRE PROTECTION BUREAU—PLAN REVIEW I�, PO Box 42600 "^"a"'"�' � MIfSNEiVGTS�M STAVlE MrA�S. Olympia WA 98504-2600 ••, « � (360) 596-3911 FAX. (360) 596.3934 Uor CONTRACTORS' MATERIALS AND TEST REPORT FOR ABOVEGROUND PIPING PROCEDURE Upon completion of work, inspection and test shall be made by the contractor's representative and witnessed by an owner's representative,. All defects shall be corrected and system left in service before contractor's personnel finally leave the job. A certificate shall be filled out and signed by bath representatives. Copies shall be prepared for approving authorities, owners, and contractor. It is understood the owner's representative's signature in no way prejudices any claim against contractor for faulty material, poor workmanship, or failure to comply with approving authority's requirements or local ordinances. PROPERTY NAME DATE PROPERTY ADDRESS Q I W ACCEPTED BY APPROVING A T HORITIES(NAME) ADDRE, PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS C,"t ?ES C1 NO EQUIPMENT USED IS APPROVED CAS 0 NO IF NO,EXPLAIN DEVIATION HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION OF CONTOL VALVE AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT? YES le'NO IF NO,EXPLAIN INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: 1. SYSTEM COMPONENTS INSTRUCTIONS S [--]NO 2. CARE AND MAINTENANCE INSTRUCTIONS NO 1 NFPA 13 ES ❑NO LOCATION SUPPLIES BUILDINGS OF SYSTEM MAKE MODEL YEAR OF ORIFICE SIZE QUANTITY TEMPERATURE RATING MANUFACTURE r SPRINKLERS TYPjEE OF PIPE PIPE AND q V (- FITTINGS TYPE OF FITTINGS ALARM DEVICE MAXIMUM TIME TO OPERATE THROUGH TEST CONNECTION TYPE MAKE MODEL MINUTES SECONDS ALARM VALVE OR PLOW INDICATOR 30aa-45"01 W Page 1 DRY VALVE QUICK OPENING DEVICE MAKE MODEL SERIAL NO, MAKE MODEL SERIAL NO. TIME TO TRIP TRIP POINT TIME WATER ALARM OPERATED THRU TEST WATER AIR PRESSURE AIR REACHED TEST DRY PIPE CONNECTION PRESSURE PRESSURE OUTLET PROPERLY OPERATING TEST MIN SEC PSI PSI PSI MIN SEC YES NO WITHOUT Q.O.D. WITH Q.O.D. IF NO,EXPLAIN OPERATION ❑ PNEUMATIC ❑ ELECTRIC ❑ HYDRAULIC PIPING SUPERVISED ❑ YES ❑ NO DETECTING MEDIA SUPERVISED ] YES ❑ NO DOES VALVE OPERATE FROM THE MANUAL TRIP AND/OR REMOTE CONTROL STATIONS? ❑ YES ❑ NO DELUGE Ii IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT FOR 7ESTNG? IF NO,EXPLAIN PREACTION ❑ YES © NO VALVES DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT OPERATE MAXIMUM TIME TO OPERATE MAKE MODEL SUPERVISION LOSS ALARM? VALVE RELEASE? RELEASE YES NO YES NO YES NO HYDROSTATIC, Hydrostatic levels shall be made at not less that 200 psi(13.6 bars)for two hours of 50 psi(3.4 bass)above static pressure In excess of 150 psi(10.2 bars)for two hours. Differential dry-pipe valve clappers shall be left open during test to prevent damage. All aboveground TEST piping leakage shall be stopped. DESCRIPTION PNEUMATIC: Establish 40 psi(2.7 bars)air pressure and measure drop which shall not exceed 1 Yz psi(0,1 bars)in 24 hours. Test pressure tanks at normal water level and air pressure and measure air pressure dro whlch shall not exceed 1'/: si 0.1 bars in 24 hours ALL PIPING HYDROSTATICALLY TESTED AT �0 FOR HRS DRY PIPING PNEUMATICALLY TESTED IF N0,STATE REASON EQUIPMENT OPERATES PROPERLY � ._ ❑YES ❑NO ❑YES ❑Nq DO YOU CERTIFY AS THE SPRINKLER SYSTEM CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS,SODIUM SILICATE OR DERIVATIVES OF SODIUM SILICATE, BRINE OR OTHER CORROSIVE CHEMICALS WERE NOT USED FOR TESTING SYSTEMS OR STOPPING LEAKS? ❑YES ❑NO DRAIN READING OF GAGE LOCATED NEAR WATER SUPPLY TEST RESIDULE PRESSURE WITH VALVE IN TEST TESTS TEST CONNECTION: PSI CONNECTION OPEN WIDE, PSI UNDERGROUND MAINS AND LEAD IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO SPRINKLER PIPING. VE IED BY COPY OF THE U FORM NO 95B ( ES ❑NO FLUSHED BY INSTALLER OF UNDERGROUND SPRINKLER PIPING 0 YES ❑NO IF NO,EXPLAIN BLANK TESTING, NUMBER USED LOCATIONS NUMBER REMOVED GASKETS WELDED PIPING ❑YES ❑NO IF YES,COMPLETE BELOW 00 YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST AWS D10.9,LEVEL AR-3? ❑YES ❑NO WELDING COMPLIANCE YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS D10.9,LEVEL AR-3? ❑YES ❑NO DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A DOCUMENTED QUALITY CONTROL PROCEDURE TO ENSURE THAT ALL DISCS ARE RETRIEVED,THAT OPENINGS IN PIPING ARE SMOOTH,THAT SLAG AND OTHER WELDING RESIDUE ARE REMOVED,AND THAT THE INTERNAL DIAMETERS OF PIPING ARE NOT PENETRATED? ❑YES ❑N0 CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL DISCS CUTOUTS DISCS ARE RETRIEVED? ❑YES El NO FUNCTIONAL DOES AHJ REQUIRE A FUNCTIONAL FLOW TEST OF RESIDENTIAL SPRINKLERS? ❑YE5 []NO FLOW TEST WERE FUNCTIONAL FLOW TEST RESULTS SATISFACTORY? ❑YE5 ❑NO HYDRAULIC NAME PLATE PROVIDED ❑YES ❑NO IF NO,EXPLAIN DATA NAMEPLATE REMARKS DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: (] G YT( NAME OF SPRINKLER CONTRACTOR CONTRACTOR LICENSE# DATE SIGNATURES TESTS WITNESSED BY tiNNER OVREPFJtSENTATIVE TITLE DATE r�� zffi 3000450-001 7107 Page 2 i FIDE PROTECTION BUREAU— PLAN REVIEW ' PO Box 42600 n � a Nsrnicxro* HiE Olympia WA 99504-2600 4A4�a'` (360}596-3911 FAX: (360) 596-3934 _ CONTRACTORS' MATERIALS AND TEST REPORT FOR ABOVEGROUND P'IP'ING PROCEDURE Upon completion of work, inspection and test shall, be made by the contractor's representative and witnessed by an owner's representative. All defects shall be corrected and system left in service before contractor's personnel finally leave the job. A certificate shall be filled out and signed by both? representatives. Copies shall be prepared for approving authorities, owners, and contractor. It is understood the owner's representative's signature in no way prejudices any claim against contractor for faulty material,, poor workmanship, or failure to comply with approving authority's requirements or local ordinances. PROPERTY NAME DATE I PROPERTY ADDRESS N/4 LJ . ACCEPTED BY,APPROVING AUTHORITIES(NAME) 8 A14 C✓cC ADDRESSI PLANS INSTALLATION CONFORMS TO ACCEPTED PLAN'S S ONO EQUIPMENT USED'IS APPROVED S ❑NO IF NO,EXPLAIN DEVIATION HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION OF CONTOL VALVE AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT? YES NO IF NO,EXPLAIN INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: 1. SYSTEM COMPONENTS INSTRUCTIONS flRSGES ❑NO 2, CARE AND MAINTENANCE INSTRUCTIONS Y�S ❑NO 1 NFPA 1',3 4ES ❑NO LOCATION SUPPLIES BUILDINGS OF SYSTEM'.. MANGE MODEL YEAR OF MANUFACTURE ORIFICE SIZE QUANTITY TEMPERATURE RATING SPRINKLERS TYPE OF PIPE PIPE AND p F'ITTIN'GS TYPE OF FITTINGS ALARM DEVICE MAXIMUM TIME TO OPERATE THROUGH'TEST CONNECTION' TYPE MANGE MODEL MINUTES SECONDS ALARM VALVE OR FLOW INDICATOR 3000-a50-001 7/07 Page 1 DRY VALVE QUICK OPENING DEVICE MAKE MODEL SERIAL NO, MAKE MODEL SERIAL,NO. T HRUTEST WATER AIR PRESSURE TRIP AIR INT RE AC TEST ALARM OPERATED DRY PIPE CONNECTION PRESSURE PRESSURE OUTLET PROPERLY OPERATING TEST MIN I SEC PSI PSI PSI MIN SEC YES NO WITHOUT Q.O.D. WITH O.O.D. IF NO,EXPLAIN OPERATION ❑ PNEUMATIC ❑ ELECTRIC ❑ HYDRAULIC PIPING SUPERVISED ❑ YES ❑ NO DETECTING MEDIA SUPERVISED ❑ YES ❑ NO DOES VALVE OPERATE FROM THE MANUAL TRIP AND/OR REMOTE CONTROL STATIONS? ❑ YES ❑ NO DELUGE& IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT FOR TESTING? IF NO,EXPLAIN PPEAATION ❑ YES ❑ NO VALVES DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT OPERATE MAXIMUM TIME TO OPERATE MAKE MODEL SUPERVISION LOSS ALARM? VALVE RELEASE? RELEASE YES NO YES NO YES NO ( ' le less 4 that 2010 psi(13.6 bars)for two hours of 50 psi(3. bars)abovegstabc pressure in excess of 1501 psi Hydrostatic 0.2 bars)for two hours.eO ffe ential dry-p pe valve clappers shall be left open during test to prevent damage, All aboveground TEST piping leakage shall be stopped. DESCRIPTION PNEUMATIC: Establish 40 psi(2.7 bars)air pressure and measure drop which shalt not exceed 1 %psi(0,1 bars)in 24 hours. Test pressure tanks at normal water level and air pressure and measure air pressure drop which shall not exceed 1 "/ si 0.1 bars in 24 hours ALL PIPING HYDROSTATICALLY TESTED AT &0 FOR FIRS IF NO,STATE REASON Gy DRY PIPING PNEUMATICALLY TESTED ❑YES ❑NO r EQUIPMENT OPERATES PROPERLY ❑YES ❑ NO DO YOU CERTIFY AS THE SPRINKLER SYSTEM CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS,SODIUM SILICATE OR DERIVATIVES OF SODIUM SILICATE,BRINE OR OTHER CORROSIVE CHEMICALS WERE NOT USED FOR TESTING SYSTEMS OR STOPPING LEAKS? ❑YES ❑NO DRAIN READING OF GAGE LOCATED NEAR WATER SUPPLY TEST RESIDULE PRESSURE WITH VALVE IN TEST TESTS TEST CONNECTION PSI I CONNECTION OPEN WIDE:' PSI UNDERGROUND MAINS AND LEAD IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO SPRINKLER PIPING. VE ED BY COPY OF THE U FORM NO 858 (; AYES ❑NO FLUSHED BY INSTALLER OF UNDERGROUND SPRINKLER PIPING I 'YES ❑ NO IF NO,EXPLAIN BLANK TESTING NUMBER USED LOCATIONS NUMBER REMOVED GASKETS WELDED PIPING ❑YES ❑NO IF YES,COMPLETE BELOW DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST AWS D10.0,LEVEL AR-3? ❑YES ❑NO WELDING DO YOU CERTIFY THATTHE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS D10.9,LEVEL AR-3? ❑YES ❑NO DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A DOCUMENTED QUALITY CONTROL PROCEDURE TO ENSURE THAT ALL DISCS ARE RETRIEVED,THAT OPENINGS IN PIPING ARE SMOOTH,THAT SLAG AND OTHER WELDING RESIDUE ARE REMOVED,AND THAT THE INTERNAL DIAMETERS OF PIPING ARE NOT PENETRATED? ❑YES ❑ NO CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL DISCS CUTOUTS DISCS ARE RETRIEVED? ❑'YES ❑NO FUNCTIONAL DOES AHJ REQUIRE FUNCTIONAL FLOW TEST OF RESIDENTIAL SPRINKLERS? ❑YES ❑NO FLOW TEST WERE FUNCTIONAL FLOW TEST RESULTS SATISFACTORY? YES ❑NO HYDRAULIC NAME PLATE PROVIDED IF NO,EXPLAIN DATA NAMEPLATE ❑YES ❑NO REMARK _ DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: NAME OF SPRINKLER CONTRACTOR CONTRACTOR LICENSE# DATE, SI Rte" TESTS WITNESSED BY OWN 0 REP ESENTATIVE TITLE DATE r 3000-4-53-001 7107 Page 2 CONTRACTORS' MATERIALS & TEST REPORT FOR ABOVEGROUND PIPING WAS PROCEDURE Upon Completion of work, inspection and test shall be made by the contractor's representative and witnessed•by an owner's representative. All defects shall be corrected and system left in service before contractor's personnel finally leave the job. A certificate shall be filled out and signed by both representatives. Copies shall be prepared for approving authorities, owners, and contractor. It is understood the owner's representative's signature in no way prejudices any claim against contractor for faulty material, poor workmanship, or failure to comply with approving authority's requirements or local ordinances. PROPERTY NAME —DATE HINGrON ST47t MTN% UM-W PROPERTY ADDRESS �2b, 131 E7 AC EPTEO BY APPROVING AUTHORITIES(NAME) ADDRESS PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS 0 YES ONO EQUIPMENT USED IS APPROVED 0 YES ONO IF NO,EXPLAIN DEVIATION HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION OF CONTOL VALVE AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT? YES ONO IF NO,EXPLAIN INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON TI-Itz PREMISES: I. SYSTEM COMPONENTS INSTRUCTIONS DYES ONO Z CARE AND MAINTENANCE INSTRUCTIONS 0 YES ONO 3, NFPA13 OYES ONO LOCATION SUPPLIES BUILDINGS OF SYSTEM MAKE MODEL YEAR OF ORIFICE SIZE QUANTITY TEMPERATURE RATING MANUFACTURE SPRINKLERS TYPE F PIPE PIPE AND FITTINGS TYPE OF FITTINGS INUS ALARM DEVICE MA)WUM TIME TO OPERATE THROUGH TEST CONNECTION TYPE MAKE MODEL MINUTES SECONDS ALARM VALVE OR FLOW INDICATOR 3000-450-ODI 91()2 DRY VALVE QUICK OPENING DEVICE MAKE MODEL SERIAL NO, MAKE MODEL SERIAL NO.. TIME TO TRIP TRIP POINT TIME WATER ALARM OPERATED THRU TEST WATER AIR PRESSURE AIR REACHED TEST DRY PIP!* CONNECTION PRESSURE PRESSURE OUTLET PROPERLY OPERATING TEST MIN SEC PSI PSI PSI MIN SEC YES NO WITHOUT WITH Q.O.D. IF NO„EXPLAIN OPERATION C7 PNEUMATIC ELECTRIC C7 HYDRAULIC PIPING SUPERVISED El YES ❑ NO DETECTING MEDIA SUPERVISED El YES D NO DOES VALVE OPERATE FROM THE MANUAL TRIP ANDIOR REMOTE CONTROL STATIONS? J YES G 1 NO DELUGE& IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT FOR TESTING? IF NO,EXPLAIN PREACTION 0 YES CI NO VALVES DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT OPERATE MAXIMUM TIME TO OPERATE MAKE MODEL SUPERVISION LOSS ALARM? VALVE RELEASE? RELEASE YES NO YES NO YES NO HYDROSTATIC: Hydrostatic levels shall be made at net less that 200 psi(13.6 Tsars)for two hours of 50 psi(3.4 bars)above static pressure in excess of 150 Psi(10.2 bars)for tvwo.lours. Differential dry-pipe valve clappers shall be left open during test to prevent damage. All aboveground TEST piping leakage shall be stopped. DESCRIPTION PNEUMATIC: Establish 40 psi(2.7 bars)air pressure and measure drop which shall not exceed 1''A psi(0.1 bars)in 24 hours. Test pressure tanks at normal water level and air 2rersure and measure air pressure drop which shall not exceed 1'4 psi 0.1 bars in 24 hours �` ALL PIPING HYDROSTATICALLY TESTED AT FOR HRS IF NO,STATE REASON t J DRY PIPING PNEUMATICALLY TESTED EI YES D NO EQUIPMENT OPERATES PROPERLY (]YES a NO DO YOU CERTIFY AS THE SPRINKLER SYSTEM CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS,SODIUM SILICATE OR DERIVATIVES OF SODIUM SILICATE,BRINE OR OTHER CORROSIVE CHEMICALS WERE NOT USED FOR TESTING SYSTEMS OR STOPPING LEAKS? CI YES ®NO DRAIN READING OF GAGE LOCATED NEAR WATER SUPPLY TEST RESIC7ULE PRESSURE WITH VALVE IN TEST TESTS TEST CONNECTION. PSI CONNECTION OPEN WIDE: PSI UNDERGROUND MAINS AND LEAD IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO SPRINKLER PIPING. r VERIF BY COPY OF THE U FORM NO 135E 0 5 S ❑NO LUSHED BY INSTALLER OF UNDERGROUND SPRINKLER PIPING L,ki""YES ❑NO IF NO,EXPLAIN BLANK TESTING NUMBER USED LOCATIONS NUMBER REMOVED GASKETS WELDED PIPING ❑YES El NO IF YES,COMPLETE BELOW DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST AWS D10.9,LEVEL AR-3? El YES ®NO WELDING DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS D10.9,LEVEL AR-3? El YES Ej NO DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A DOCUMENTED QUALITY CONTROL PROCEDURE TO ENSURE THAT ALL DISCS ARE RETRIEVED,THAT OPENINGS IN PIPING ARE SMOOTH,THAT SLAG AND OTHER WELDING RESIDUE ARE REMOVED,AND THAT THE INTERNAL DIAMETERS OF PIPING ARE NOT PENETRATED? 0 YES ONO CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL (DISCS) CUTOUTS DISCS ARE RETRIEVED? ❑YES 0 NO FUNCTIONAL DOES AHJ REQUIRE A FUNCTIONAL FLOW TEST OF RESIDENTIAL SPRINKLERS? YES Ij NO FLOW TEST WERE FUNCTIONAL FLOW TEST RESULTS SATISFACTORY? El YES El NO HYDRAULIC IF NO,EXPLAIN DATA NAMEPLATE NAME PLATE PROVIDED CJ YES El NO REMA DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: NAME OF SPRINKLER CONTRACTOR CONTRACTOR LICENSE# DATE SIGNATURES TESTS WITNESSED BY P OWNER REP ES TATIVE TITLE DATE sr , �'�